| ObjectiveDepression is a mental illness which severely reframes individuals’social function and reduces their quality of life.Its main symptoms are feeling down and anhedonia,accompany with different degrees of physical symptoms,cognitive and behavioral changes,which may lead to behaviors such as self-harm or suicide.Depression often occurs in late-adolescence and early-adulthood,and studies have verified that being depressed during this period increased the risk for subsequent depression after adulthood.Many factors contribute to the occurrence of depression,among which childhood traumas increase the risk for major depressive disorder(MDD),however,the predictive effect and mechanism of childhood trauma on depression remains clear,which might be of great significance for optimizing treatment of MDD.Psychotherapy has gained wide attention as a treatment method for depression.Specifically,studies have shown that loving-kindness meditation(LKM),as a new psychotherapy method,can help practitioners better recognize and experience positive emotions,increase their positive resources,and further reduce the impact of childhood trauma on individuals.Individuals with childhood trauma experience have a high level of self-criticism,and LKM can also reduce their level of self-criticism,probably reduce their depression,which need more evidence.Based on this,this study conducted a survey in the general population and patients with depression to explore the predictive effect of childhood trauma on depression and its possible mediating mechanism based on the vulnerability-stress model.Based on literature,combined with the clinical characteristics of individuals with childhood trauma and patients with MDD,a psychological intervention based on the loving-kindness meditation was constructed and applied to depressive patients with or without childhood trauma experience to observe its therapeutic effects,which offer reliable evidence for clinical nurses referring to psychological nursing care for patients.Methods1.Prediction of childhood trauma on depression in the general population510 university students were investigated with Beck depression inventory-Ⅱ(BDI-Ⅱ),Childhood Trauma Questionnaire-28 item Short Form(CTQ-SF),Eysenck personality questionnaire(EPQ),Self-description Task(SDT),Coping Style Questionnaire(CSQ),Adolescent Self-rating Life Events Checklist(ASLEC),Social Support Rating Scale(SSRS),and Connor-Davidson Resilience Scale(CD-RISC)at T1(2016).After this,433subjects were investigated 3 times(T2-T4,2017-2019)with BDI-Ⅱ,ASLEC,SSRS,and CD-RISC at an interval of one year.The data used to construct and test the predictive model of childhood trauma on depression,and to explore the mediating effect of the above psychological variables between childhood trauma and depression.2.Prediction of childhood trauma on clinical depressionBDI-Ⅱ,CTQ-SF,EPQ,CD-RISC was used to survey 115 patients with MDD,to construct and verify the predictive model of childhood trauma on depression,and to explore the mediating effect of personality and resilience between childhood trauma and depression3.Effect of psychological intervention based on the loving-kindness meditation on patients with MDD61 patients with MDD were selected by the convenient sampling method.According to the scores of CTQ-SF and interviews,the subjects were divided into two groups:childhood trauma positive group and childhood trauma negative group.The patients were randomly divided into the LKM group(30 cases,CTQ positive/negative:25/5)and the control group(31 cases,CTQ positive/negative:26/5).The LKM group was given psychological intervention based on the LKM for 8 weeks,while the control group received disease health education.BDI-Ⅱwas used to measure the depression level of the two groups before and after the intervention,and the effect of the intervention was evaluated.4.Potential psychological and physiological mechanism behind the effect of psychological intervention based on the LKM on patients with MDDBefore and after the intervention,the patients of the two groups were assessed by SDT,CD-RISC,Subjective Happiness Scale,and some key inflammatory indicators(intervention group n=24,control group n=5),such as serum IL-6,C-reactive protein,complement(C3and C4),immunoglobulin(Ig A,Ig G,Ig M,Ig E),)to explore the potential mechanism behind the effect of LKM on patients with MDD.Results1.In general people,depression was positively correlated with childhood trauma,psychotic personality,neurotic personality,negative self-description,life events,as well as the self-blame,fantasy,withdrawal,and rationalization in the coping styles,and negatively correlated with extroverted personality,positive self-description,social support,resilience,problem-solving and help-seeking in coping styles.In the patients with MDD,the level of depression was positively correlated with childhood trauma and its sub-dimensions,neurotic personality,and psychotic personality,and negatively correlated with extroverted personality and resilience.2.In general people,model test showed that the overall effect of childhood trauma on depression was 0.32(P<0.01),among which the indirect effect was 0.25(P<0.01),and the corresponding 95%CI(0.18～0.32)which did not contain 0,indicating that the mediating effect between childhood trauma and depression was significant,accounting for 78.12%of the total effect.Neuroticism,negative self-description,fantasy,life events,social support,and resilience partially exerted the mediating roles.The T1-T4 instant model showed that the direct effect of childhood trauma on T1 depression was 0.09,and the indirect effect value was 0.13 through life events,resilience,and social support(P<0.01).Childhood trauma had no direct effect on T2-T4 depression and only had an indirect effect through the mediation of life events,resilience,and social support,the effect values of which were 0.13,0.07,and 0.12(P<0.01),respectively.The delayed model showed that childhood trauma indirectly predicted T4 depression through T1 depression,life events,social support,and resilience in T1 and T4,the effect value of which was 0.09.3.In MDD patients,model test showed that the overall effect of childhood trauma on depression was 0.30(P<0.01),among which the indirect effect was 0.16(P<0.05),accounting for 53.33%of the total effect.Neuroticism and psychological resilience played a chain mediating role in the effect of childhood trauma on depression.4.In the intervention study,the repeated measurements of 2(intervention group,control group)*2(childhood trauma positive,negative)*2(pre-test,post-test)were used in analysis,the results showed that for the scores of depression,resilience,negative self-description,and positive self-description,there were significant interaction effects:groups(intervention group,control group)*time(pre-test,post-test)[F(1,57)=7.63,P=0.008,η_p~2=0.12;F(1,57)=5.24,P=0.026,η_p~2=0.08;F(1,57)=9.00,P=0.004,η_p~2=0.14;F(1,57)=4.59,P=0.036,η_p~2=0.08],while the interaction for happiness score was not significant.Further simple effect analysis showed that groups differed significantly on depression,resilience,negative self-description,and positive self-description in the post-test.The scores of depression and negative self-description in the intervention group with CTQ positive and CTQ negative were significantly lower than those in the control group,while the scores of resilience and positive self-description in the intervention group were significantly higher than those in the control group.6.No significant differences were indicated in the interleukin-6,C-reactive protein,complement C3,and C4,immunoglobulin Ig A,immunoglobulin Ig G,immunoglobulin Ig M,and immunoglobulin Ig E between the two groups before and after the intervention(P>0.05).Conclusions1.In the general population,depression is positively correlated with childhood trauma,psychotic personality,neurotic personality,negative self-description,life events,as well as the self-blame,fantasy,withdrawal,and rationalization in the coping style;and negatively correlated with extroverted personality,positive self-description,social support,resilience,as well as the problem-solving and help-seeking in the coping style.In the patients with MDD,the level of depression is positively correlated with childhood trauma and its sub-dimensions,neurotic personality,and psychotic personality,and negatively correlated with extroverted personality and resilience.2.In the general population,childhood trauma has a positive predictive effect on depression,and a stable effect on depression through the comprehensive mediation of neuroticism,negative self-description,fantasy coping style,life events,and resilience.Life events,social support,and resilience play immediate and delayed dynamic mediating roles in the effect of childhood trauma on depression.3.In the group of patients with MDD,childhood trauma has a positive predictive effect on the level of depression and indirectly affects the level of depression through the chain mediation of neuroticism and resilience.4.Psychological intervention based on the loving-kindness meditation could reduce the level of depression in depressive patients with childhood trauma,improve their level of resilience,reduce their negative self-description and enhance their positive self-description.However,the effect of the intervention on depressive patients without childhood trauma needs to be further verified by increasing the sample size.At present,it can not be concluded that the intervention is more effective for depressive patients with childhood trauma experience. |
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